I. INTRODUCTION

The methods followed by the French in returning men discharged from the armies to civilian life have by no means reached a final form. The war created in France many needs insufficiently provided for by existing social organization. Public and private energies immediately produced a host of new bodies designed to meet those needs (Appendices B and D); while they have done so, often well, it has become very evident that the functions with which they are concerned would be more advantageously fulfilled were the energies of which they dispose employed with better system. Various Bills have been proposed with the object of securing so desirable an end (Appendix G); they are being considered by the French legislative bodies and some of them will surely become law (Appendix G-54).

As a rule, the laws by which France secures the return of her soldiers and sailors, disabled or sound, to their homes are in harmony with the republican principles which underlie her constitution. At times, however, expediency or conservative respect for tradition has made it difficult for French legislators to secure an ideal adherence to those principles in the drafting of existing or proposed statutes. So it is that, at present, the laws governing the return of soldiers and sailors to their homes from the French

'Armies of Land and Sea' are still in a period of active change. Some of them will be abolished or altered; others may persist; and, certainly, new laws will be made to meet conditions at present regulated, insufficiently, or not at all. The intense desire, conspicuous everywhere in France, to do whatever may be best for the nation makes it probable that the legislation finally adopted will be ideal in its provisions; a Bill recently

adopted by the 'Chambre des Députés' (Appendix G-54) constitutes a strong promise that it will be so.

As far as possible, this report is impersonal. It is based entirely upon written (Appendices B, D, F, and G) or verbal (Appendices A, C, and E) information received from Frenchmen whose duties make them competent to express opinions on this subject with authority. Information has always been obtained from men, or commissions, entrusted with the work rather than from the titular heads of Ministries or of Departments. Consequently, while the report pretends to accurate representation of existing conditions it places in relief those methods which are considered most apt to the purpose for which they are designed. Gratuitous detail is avoided; but it is endeavored to give a coherent and comprehensive account of the main features of the situation in France and, especially, to indicate points where French experience may prove to be of advantage in suggesting measures suitable for Canada (See Section XVIII, page 37).

France has passed through difficulties which are only commencing to present themselves to Great Britain and to Canada. She has felt and reasoned her way to the methods most suitable for coping with them. It would be unfortunate were Canada not to take full advantage of the lessons which French experience so plainly points; but it will be found that, because of national differences, measures suited to France can not always be usefully initiated, without modification, in Canada.

The processes by which the return to his home of a discharged wounded or disabled soldier, or sailor, is secured may be divided conveniently into the following stages:

II.

1. Active medical and surgical treatment;

2. Functional re-education,

3. The provision of artificial appliances; 4. Professional re-education;

5. Establishment in civilian life.

ACTIVE MEDICAL AND SURGICAL TREATMENT

For military purposes the territory of France and her colonies is divided into twenty-one military regions. Each region has an organization of its own, complete in itself; this fact is taken advantage of in many ways in arranging for the return of soldiers from the armies to their homes. It is estimated that about 30 to 40 per cent. of the men composing the French army will be admitted to hospitals because of disease or wounds. Active medical and surgical treatment is given to soldiers by the French Medical Service, in a host of hospitals. Hospitals may be established by military authority, by civilian authority, or by the efforts of private benevolence; hospitals supported by private benevolence may be maintained either through individuals or through societies such as those constituting the French Red Cross Society (Appendix D-62). All of these hospitals are under the Minister of War (Service de Santé).

In addition to general hospitals, institutions for special purposes, such as the treatment of skin diseases or for the repair of injuries to the teeth or jaws, have been established by the medical service when and where they have been required. Among the most important of the special hospitals are the orthopedic centers. As it happens, there is one of these in each of the army regions which, for military purposes, divide France into twenty areas. Their situations, however, were chosen primarily so that communication with the manufacturers of artificial limbs might be easy. Since many of the manufacturers are in Paris, it follows that several orthopedic centers are in Paris, or near it. Cases requiring orthopedic treatment are sent to these centers from the area which each serves.

The military hospitals established in the 'Asile National des Convalescents' at SaintMaurice (Appendix A-10) and that established in the Grand Palais, Paris (Appendix A-6), are examples of orthopedic centers. They draw their patients from hospitals in the neighborhood

of Paris. They are equipped with the staff and appliances necessary both for performing any secondary operations of a special nature which may be necessary and for undertaking functional re-education.

Patients sent to the orthopedic centers are carefully examined and, if it is advisable, operations are performed. At first, it was necessary to operate on a considerable percentage of the cases of amputation, because of adherent scars and nerves, or because of insufficiently covered bones, or persistent infection, or similar conditions. The percentage of cases requiring re-operation is now much less-perhaps about two per cent. at the Maison-Blanche (Appendix A-7).

At these hospitals, the stump of every patient who has suffered an amputation is radiographed on his admission. The radiographs have been invaluable both clinically and as records. By them exostoses have been found to be remarkably frequent, especially in the femur; they often cause a stump to be painful. It has been found inadvisable, as a routine, to remove them at once since a dormant infection often has been lighted up by the operation and has resulted in unfortunate suppuration.

A very convenient way of recording the findings of the X-ray room in the patient's papers is to make a tracing of the skiagraph on tissue paper. Black is used for the outlines of the skin, blue for the outlines of bone, red for the outlines of pathological structures and red, blocked in, for foreign bodies. (The description of recent developments in medical science such as of the method by which a balanced magnet is employed for finding iron bodies in wounds does not enter the scope of this report.)

III. FUNCTIONAL RE-EDUCATION Functional re-education is the term under which are grouped all of the means adopted to secure the existence of a maximum of its normal function to an injured part. Judicious re-education of a part injured should be commenced as soon as is possible, but, usually, it is not until active hospital treatment has done all that it can do that functional re-education is really commenced.

The nature of the treatment by which functional re-education is to be carried on is pre